Diet Questionnaire

First Name

Last Name:

Gender:
MaleFemale

Country:

Email Address:

Height:

Weight:

Desired Goal:

Desired Weight:

Body Type:
EctomorphMesomorphEndomorph

Have you ever been on a diet? If yes, please describe what type of diet:

How many times per day do you eat?12345 or more

Briefly describe what kind of food you usually eat?

Are you allergic to any foods? If yes, what kinds?

Do you work out? If yes, how many times per week?neveronce a weektwice a week3 or more times a weekeverydayseveral times a day

Would you like your personalized diet plan to include the use of supplements?YesNo

How did you find out about lostfit.com?